title: Hospital center effect for laparoscopic colectomy among elderly stage I-III colon cancer patients.
abstract: OBJECTIVE
  To investigate hospital-level variation in short-term laparoscopic colectomy outcomes among stage I-III elderly colon cancer patients.
  
  
  BACKGROUND
  Surgical outcomes are associated with patient and surgeon characteristics. If outcomes are also impacted by the hospital where the surgery occurs, there is a hospital center effect (HCE).
  
  
  METHODS
  Surveillance, Epidemiology, and End Results (SEER)-Medicare data was used to identify stage I-III colon cancer patients treated with laparoscopic colectomies. Multilevel regressions were utilized to study potential HCE for length of stay (LOS), 30-day rehospitalization, and in-hospital mortality, adjusting for patient, surgeon, and hospital-level characteristics. To quantify HCE, we calculated the median instantaneous rate ratio (MIRR) for LOS and median odds ratio (MOR) for in-hospital mortality and 30-day rehospitalization. Sensitivity analyses were conducted for high volume/medical school affiliated hospitals and colorectal surgeons.
  
  
  RESULTS
  The multilevel analyses based on 4617 patients from 465 hospitals documented statistically significant HCEs for LOS (MIRR = 1.35; P < 0.001) and in-hospital mortality (MOR = 1.69; P = 0.032), but no HCE for 30-day rehospitalization. Sensitivity analyses confirmed our findings. HCE was significant for LOS in all sensitivity analyses and was significant for in-hospital mortality for high volume/medical school affiliated hospitals.
  
  
  CONCLUSIONS
  HCE exists for LOS and in-hospital mortality of laparoscopic colectomy, which suggests that the choice of hospital affects outcomes independently of other confounding variables. Reducing the variation in outcomes associated with HCE may improve the quality of cancer care.
authors.affiliation: *Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy †Department of Surgery, Division of General and Oncologic Surgery, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zheng
authors.forename: Nader
authors.initials: N
authors.lastname: Hanna
authors.forename: Eberechukwu
authors.initials: E
authors.lastname: Onukwugha
authors.forename: Kaloyan A
authors.initials: KA
authors.lastname: Bikov
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D009367:Neoplasm Staging; D011787:Quality of Health Care; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology